Long-Term Opioid Use Health Risks Worse Than Thought?

Long-Term Opioid Use Health Risks Worse Than Thought?

By Ed Coghlan

The debate over the prescription of opioids to treat chronic pain surfaced again this week.

Research is out showing that opioids are contributing to more heart-related and other deaths?

Patients who use opioids had a 64% higher risk of dying within six months of starting treatment compared to patients taking other prescription pain medicine.

The study was published in the Journal of the American Medical Association this week.

Lead author Wayne Ray, Ph.D., and colleagues with the Vanderbilt Department of Health Policy studied 45,000 Tennessee Medicaid patients between 1999-2012 with chronic pain, primarily back and other musculoskeletal pain, who did not have cancer or other serious illnesses. The study authors noted that the body’s prolonged exposure to the drugs may increase risks for toxic reactions.

Researchers compared those starting a long-acting opioid to those taking an alternative medication for moderate-to-severe pain.

Alternative medications included both anticonvulsants — typically prescribed to prevent seizure activity in the brain, treat bipolar disorder or neuropathic pain — and low doses of cyclic antidepressants, which are taken for depression, some pain and migraines.

“We found that the opioid patients had a 64 percent increased risk of death for any reason and a 65 percent increased risk of cardiovascular death,” said Ray, professor of Health Policy at Vanderbilt University School of Medicine.

“The take-home message for patients with the kinds of pain we studied is to avoid long-acting opioids whenever possible. This is consistent with recent Centers for Disease Control and Prevention guidelines. This advice is particularly important for patients with high risk for cardiovascular disease, such as those with diabetes or a prior heart attack.”

If a long-acting opioid is the only option for effective pain relief, patients should start with the lowest possible dose and only gradually increase it, he said.

This study comes as the federal government continues to ratchet up attention on what it believes to be the dangers of opioids.

The Centers for Disease Control developed and published the CDC Guideline for Prescribing Opioids for Chronic Pain to provide recommendations for the prescribing of opioid pain medication for patients 18 and older in primary care settings.

The Guideline, which was finalized in March of this year, has divided much of the pain community. A sizeable (and very frustrated) portion of the pain community believes that the government’s concern over the prescription of opioids is hurting patients who take them responsibly to treat their pain, often intractable chronic pain.

Others are concerned at the prescribing practices of mostly family practice physicians.

Subscribe to our blog via email

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Authored by: Ed Coghlan

There are 51 comments for this article
  1. Tim Mason at 5:02 am

    I get my statistics from NIH articles. Pub Med is the best and only way to search and find accurate and unbiased results on medical studies and illnesses.
    The bulk of questions are answered in this article: PCMID: PMC 3537878 (free)
    You can also find the study for methadone. Methadone is also highly abused and the wafers are traded among members of the addiction treatment centers. These treatment centers, because of the nature of their clients, drug test and titrate for content in the user.

  2. Nancy at 4:04 pm

    I was a clinical data analyst for a large Heath org and I can tell you that the data is only as good as the person presenting it, I could take the same data and present it in many ways all the truth but unless you understand the complexity of medical data I don’t trust any studies or data unless I have done it. First of all you have to have data when you are discussing health decsions that are based on patients age, gender, co-morbities (all diseases) where they live, income, or you are just looking at junk. It has to be based upon the same population of people or it is not valid. We called it severity adjusted not sure that is the term they use now, but we used all the diagnostic codes and the above information I mentioned to compare diseases and results. It is a very complex process and if you are not highly trained and also have the right software it is just junk in junk out. Also, remember it is who is paying for the report, follow the money, if it is a drug company they will make sure it says exactly what they want and can base it on a very small population of patients. I worked for Quality/Risk and to improve clinical outcomes so I am highly suspicious of any data unless you can see it all. The CDC would be better severed to start looking at all the new diseases coming into our Country by this current administration than wasting tax payers money on the use of opioids by chronic pain patients. It’s time to move on.

  3. Judith Jaeger at 9:45 am

    I think it would be interesting to see a break-down of how many of these deaths were from heroin, versus how many were from, oh, let’s say, Vicodin.

  4. BL at 10:44 am

    Ameritox presented some info back in 2012 regarding Medicaid patients and them having a higher rate of illegal drug use then other patients. I have put the link below. Perhaps they chose Medicadi patients because they knew Medicaid patients would reflect the outcome they wanted.

    The fact that Medicaid patients rarely have good healthcare from Medicaid providers wasn’t considered. The fact that those on Medicaid have more restrictions and limitations when accessing and receiving healthcare as well as prescriptions drugs also wasn’t considered.

    New Analysis Shows Illicit Drug Use May Vary by Payer Type: Detection Rates as High as 17 Percent-
    http://www.ameritox.com/new-analysis-shows-illicit-drug-use-may-vary-by-payer-type-detection-rates-as-high-as-17-percent/

  5. Anonomous at 11:24 am

    Dear Frank,
    While everything you wrote is so very true,
    What bothers me more is the notion that “they” think we believe this papp.
    A better idea would have been to not prescribe to new patients unless absolutely necessary. “They” should have never taken them away from people who have been using them correctly for years. “they” resorted to scaring doctors to death about prescriptions.
    If one has to stop taking them at least come up with a decent substitute. I have been off percocets, after an 11 year run, for ten days now, (I’ve decided not to chase the dragon), and while I weaned myself off (with no help from my doctor, I might add) the back pain (three failed surgeries) is back and so are my physical limitations. We are pawns surrounded by invisible kings.

  6. Tim Mason at 9:18 am

    I posted on this early on but apparently my comment did not make the cut.
    This “Study” was no doubt paid for by Grant money from tax dollars.
    Said grant money was spent by an educator and the study allowed graduate students to complete an education.

    “Follow the dollar”

  7. Frank at 7:57 am

    Its very nice to see doctors now chiming in. I wish more doctors would take a stance in this failed war on opoids and pain sufferers. I applaud those who have.

  8. Kim Pate at 9:38 pm

    The government, or whoever, should also take into account that some doctors, and pharmacies, might have a higher opioid prescribing rate because they, probably, are in a rural area where there aren’t many choices for healthcare. It doesn’t necessarily mean that there’s a “pill mill” there. It probably means that there’s a doctor, and pharmacist, doing their jobs; by doing what’s best for their patients. I believe that people who spend most of their day working on their feet will wind up with some type of chronic pain issues, sometime in their lives. Does wanting some type of pain relief, after spending all of our working days serving others, in some way, and after trying everything else, make us drug addicts, because opioids are the only thing that works well on our chronic pain? I believe, like the rest of the chronic pain community, that we are all tired of paying for the bad apples and, of everyone telling us how we feel; and it’s all in our heads, etc. I say, spend a day in my shoes, buddy, without my regular opioid/pain meds. I bet you won’t last an hour.

  9. Jean Price at 7:32 pm

    Maybe it’s a good thing the general public doesn’t really come to this site and browse!! Because if they did, and just wanted to get the gist of the first paragraph or so and the headlines…think of what they would have assumed!! Not good, in my opinion….since it makes this bogus research seem like science.

    As far as this study or research…and I use those terms loosely…such a bunch of gobbledygook! The narrow patient population, no reference to what they were given opioids for (perhaps more serious conditions causing pain), and just the general rhetoric of “down with opioids” slant…all these things point to incredulous nonsense. I have a family history of heart disease and several other risk factors, and have been on opioids for close to thirty years. And .because of some episodes of irregular and rapid heart rate and severe fatigue, plus a pending surgery…I had a cardiac cath last year. The results? Well, my cardiologist told me he hoped his heart looked as good as mine!! So tell me, am I and Granny and several others here just the exceptions? I doubt it. Same old same old…the new banner of let’s do anything we can to suppress pain meds, even if it’s lies and nonsense. Not sure this warrants these articles, except to clearly discredit the “findings” entirely.

    The better issue to study would be if the stress of untreated pain leads to heart disease! But that’s not in anyone’s best interest except patients with pain, so why bother! No one is concerned about our best interest anymore!

  10. Holly at 6:18 pm

    You didn’t list any reasons that are acceptable for her dumping you in the US, and I doubt in Canada either. Unprofessional, and grounds for malpractice (here) should you experience any untoward effects, although you probably wouldn’t be able to find a lawyer to take the case. Their prejudice is as bad as the doctors’. Also, it is their responsibility to find a doctor for you, not the other way around, but I imagine that won’t happen either. It’s a sad, sad day for medicine when we have fallen so far.

  11. Krissy at 1:43 pm

    It’s a nightmare. Hope you will let me know if you have to see an attorney. I sure hope you don’t, but if they take my meds I’m doing the same!

  12. Matt at 1:16 pm

    The Government is NOT interested in the truth, nor are they concerned about our suffering. THEY DON’T GIVE A CR*P!!! It’s about the huge amount of money to be made by herding us into addiction centers. Big financial groups like Goldman-Sachs are heavily investing in addiction centers.

    It’s about the huge profit Big Pharma is poised to make on all these new drugs that don’t work except to addict you to them.
    Take Lyrica for several years and then try to taper off. You will spend years. Trying to get off Morphine is a walk in the park in comparison.
    Abbott Labs had the patent rights to Vicodin and Purdue had Oxycotin. No problems until they became generic. Now it’s a problem.

    They are attempting to reinvent the wheel. While opium based medication is the round wheel, the others are hexagonal shaped.
    The poppy plant has been around for 4,000 years, successfully used throughout the entirety of human history until the Obama administration decided they knew better.

  13. Central Pain Syndrome Suffer at 11:42 am

    You want to see more deaths caused by opioids, keep lowering or taking away our pain medications and watch us die, and it will be a cruel, horrible, pain wrecking, and unusual death by CDC and the likes. Why you ask, because people like me with chronic pain condition that has no cure in sight will not be able to live with the pain anymore, in my state Washington, it all started in January 2015. My blood pressure is always high and I take medications for that too, because I do not have adequate control over the amount of pain that I am in which raises your blood pressure. When I did have enough pain medication, my health was so much better, but with it lowered to just 1/3 of what I use to take, my health has deteriorated over the last year and a half. As for my life, I do not have one. The only reason I am able to write right now, is my medication is working a little for about 20 minutes and then POW, it hits and runs from a 7 to a high 9 on the pain scale. My current doctors tell me to color or read to distract the pain, can you read or color when your pain is that high? It’s like telling you to go slam your hand in a car door and then go color or read. CRAZY! So like I said in the being, with CDC and their paid Doctors who are on a Witch Hunt to slowly kill off all the people in pain, you are doing a great job, hopefully none of your family or close friends will ever suffer from the cruel effects of chronic savage pain. GOD put the plant, Poppies on this earth for a reason, not to abuse it but to use it if you are suffering the effects of pain. Man has always screwed things up, but then other people do things as GOD intended like me. GOD HELP US ALL!

  14. Cora at 11:13 am

    All of this makes me so sad. I was an RN for 26 years and now for the last almost 8 years I have had chronic pain. I live in Canada and already there are rumblings of change happening in the treatment of chronic pain patients and use of opiates. Eventually in Canada we will blindly follow what the CDC dictates. In the past year my doctor has repeatedly decreased or stopped medications without discussion or compassion for the excruciating pain and profound decrease in function that I suffered as a result. From all the information coming from the US regarding opiate use in chronic pain being the demon of overdoses and addiction I took it upon myself to ask about it at my last appointment. I came at it from the point of view that if I have to come off the opiates I want to do it with a plan and slowly as I’m very sensitive to drug changes historically. Big mistake!! My doctor proceeded too tell me not to worry and this would never happen as I definitely need the opiates in conjunction with other medications and constant alternate treatments, all that I pay close to 100% for. Then my doctor told me she was not happy with our relationship and gave me notice to find another doctor. She gave many reasons for this mainly they are issues that are personal to her or a judgement to my character. So that’s great and I apologized for whatever I did to offend and still have no idea what I did really. I backed off as she was very stern and upset with me and I pacified her by saying that maybe I need fresh eyes on my case and even I have seen doctors and nurses who tire of treating non improving patients. Even though I said this I know it can be true but I am appalled at most of what she told me. Basically I left feeling she was overburdened by me and my lack of improvement and this was all my own fault. I personally have never passed off a patient to another. I would actually take these so called challenging patients as I felt it was my duty and the patient deserved it and had a right to excellent care no matter if they were getting better or not. Unfortunately medical care is become big business even in Canada and some people just stop caring because they are bound to a poorly functioning medical system that can prevent them from delivering an excellent level of care that every human has a right to have.. I have always been taught to not let your personal life or opinions or beliefs affect the care to your patient but I see more and more that there are contracts and rules for the patients but where is the obligation for healthcare professionals to first do no harm? No one is talking about the effects on the body and your physiological changes that are occurring due to chronic unmanaged pain. All the stress of unmanaged pain is stress to the infinite degree and can lead to diabetes, high blood pressure, changes to the endocrine system that effects the entire body. No one I have seen wants to talk about those things. I am also in a high risk time in my life for cardiiac issues due to genetics and being menopausal and now over weight from non opiate mediation and immobility. I also have gastric issues from NSAIDS which also cause pain adding to my plight. No one wants to see or admit to the suffering behind closed doors. Thus includes friends, family and carers. It’s astounding to me. Perhaps I’m naive despite my professional background. So again in this appointment I tried to be calm but I ended up bawling because the news that I have to find another MD while I’m not feeling well is daunting. I mostly listened to her in shock but I also has hints of this was coming because she’s been decreasing and changing my meds without discussion or planning etc. and at a time when my pain was not being managed well. She was upset when she brought up the fact that I complain that my pain is terribly managed and I’m consistently loosing function year over year and I restart at a new low best every year. I responded by saying that yes that was true and she again was offended. Why is this all only my problem? Yes I would like a cure and have my life back, but like many of us we are realistic and would like some minimal quality of life just to be able to live and not just exist minute to minute, hour to hour, and day to day. Most of us can’t plan a future we just want to get through our days maybe being able to enjoy something or to feel love and give love. You know simple things right? Shouldn’t be too much to ask. I hate studies like this that come out with astronomical conclusions that will impact our medical care in swift fashion. I haven’t read all of this study but the abstract hints of poor design leading to skewed conclusions. It’s very easily done as most researchers will admit. Six months of chronic pain patients is not the same as 5-20 years of chronic pain experience. Patients ultimately know their bodies best. It’s the lack of communication with doctors and nurses alike and the lack of a patient led care plan that used to be the cutting edge thing to do. What happened to all of that? The complexities of chronic pain are our downfall and also I think there are more females than males which changes how you are treated, It is common knowlege in healthcare that women are more frequently misdiagnosed or under treated even in critical care cardiology where I worked. Good studies have been done and this is gradually changing. Why do we have to wait for more studies as we suffer? Surely we can make improvements in treatment for chronic pain while these studies are done starting with better access to care. Two years to wait for a chronic pain specialist does not meet the mark. Two years to wait for treatment like radiofrequency ablations or spinal injections is not accptable either. We all know that if you respond to a non medication type treatment well, then you are in a position to decrease medication use. We need long term studies like 5-10 years or more to look at patients controlling age, comorbities pre and post diagnosis of chronic pain, gender , all medications used opiates, off label use meds, NSAIDS, and use of alternative treatments and lifestyle changes. There is definitely more that needs to be studied, but in the meantime chronic pain patients should not be targeted like this and the media needs to stop hyping small poorly designed studies and treatment should not be based on hypotheses or hyperpole. Back to my appointment after got my prescriptions filled and my doctor said she wouldn’t change anything else for now, I discover she’s discontinued the Nabilone I take in the day that was started by the pain clinic she sent me to. Grrrrrrr! Nuff said for today! I sure wish my brain would work like it used to I could be a fighter for our cause but that is another vunerability in our community and makes us easy targets. No one would ever revoke treatment like this for someone with Cancer. I just don’t get it :(. This is no diss to cancer patients by the way. Just want fair and equitable treatment for all regardless of what is causing the chronic pain and it’s just not happening.

  15. Anonomous at 10:21 am

    Just came from yet another MRI on my lumbar spine. Twenty years of surgeries and percosets, which were cut off from me. If my next doctors appt. with pain mgt. seeing my MRI results, leads to not getting my medication back, I will see if an attorney can help me in any way. I’ve had enough of this being treated like we are in a third world country. When the government takes all the other things (liquor, cigarettes) off the market, then maybe they have a point. Until then, something crooked is going on.

  16. Anonymous at 9:28 am

    Is this blog “Controlled Opposition”?

    Because anyone with critical thinking skills can see right through this PR piece. That was no study.

    Now, publish the Class Action Law Suits that will and ate happening due do these absurd inhumane assaults on persons with disabilities and Chronic Pain.

  17. Emma Jones at 9:06 am

    Back Pain…..Really? Not that back pain cannot be severe….but out of all the chronic pain conditions they studied back pain? Could you have been more generic? This is exactly why this studies are skewed.

  18. Angel at 8:08 am

    Another outright false claim to demonize pain patients. I don’t know 1 person bring prescribed opiods for muscle pain another outright lie to justify this inquisition. Convenient these studies always fail to mention the diseases these drugs are prescribed for like lupus MS endometriosis anklyosing spondylitis degenerative disc disease porphyria, bond of these diseases can successfully have pain managed by antidepressents

  19. Connie at 6:39 am

    Another piece of garbage. Its horrendous that the CDC, DEA and any other politically and financially motivated “studies” can and will destroy what life we as pain patients have. I can no longer take NSAIDS because of their known effect of destroying the stomach lining, I have tired taking off label anti-convulsives and other “preferred” medications for pain and between the lack of pain control and the severe side effects i cant take them either. I have tried everything short of injections (my pain is all over not in one area) including accupuncture, accupressure, physical therapy, massage, and others that i cant remember offhand and got little to no pain relief and often more pain in the process. I have been on fentanyl patches and dilaudid for close to 10 yrs now with no side effects and reasonable pain control. Where do people like myself turn now? When Obama said early in his first run for president that we would have to give end of life counseling to the elderly and chronically ill i knew that this day was coming, i had just hoped beyond all hope that the people would see what waws happening in time to stop it. With them using scare tactics the game is lost for too many of us whose voices will never be heard. Remember the scare tactics used to criminalize marijuana which is now being found has some really good medical use? This is just another round of the government playing the same games with the lives of those to whom they are supposedly employed!

  20. lyn at 6:10 am

    I am totally confused by this article .. can you talk about side effects of cymbalta , lyrica , vioxx,celebrex, mobic, paxil ,even tramadol ..most serious ones to me I listed first and surely didn’t list them all . These drugs Being Cymbalata and Lyrica and were Horrible for me to come off of, I still dont feel right after a year .. The use of opiods yes you have got to be careful ,I am a heart patient and sometimes they actually make my heart skip and Raise my BP .. But as many Drs have told me ,”its a roll of the dice” I took as pres. and have for years , I was reluctant to start at first and I haven’t been taking them for 6 months now ,by my choice . Now I can barley move , I sit most days now ,Im in horrific pain .Oh my and Humira .stelara. Talk about cardio effects and so on and so on . and I get exercise , eat low carb bal diet , drink plenty of water daily , Take probiotics .. My body always fights me , So now what ? do I do

  21. scott michaels at 12:38 am

    more lies. who are these so called patients? How old were they? How many had pr existing conditions?Not to long ago the cdc said their have NOT been any studies on long term use. Why did this study appear now and all of a sudden?
    Why are these people so greedy that they falsify and create reports that are so obviously out right lies.
    OF THE HUNDREDS and thousands THAT WE write to daily on these forums COMMUNICATE How these medications help. I have never heard of 1 person having heart problems from the medication
    HEROIN ADDICTS DONT EVEN HAVE RESULTS LIKE THE SURVEY SAID. CAN SOMEBODY PLEASE DEMAND PROOF FROM THEM AND ALL THE FACTS OF THIS OUTRAGEOUS ACCUSATION

  22. not smiling anymore at 12:15 am

    Oh great! So the lengthy argument I had with this “pain doctor” yesterday was all for nothing!?? I’m quoting the study that was done on rats NOT humans, and she’s telling me I’m wrong. So was I? Was she referring to this study quoted above? I guess I’m the fool now aren’t I? (Although, she was talking in circles, much like this article, and I could have sworn that SHE was the one on drugs!!!!)

    Regardless, I still believe that if you have retractable pain and there is a treatment option out there that may help, you shouldn’t be denied access to it. This was the very point I was attempting to make to this whacky “doctor”! She may be the specialist, but I’m the expert when it comes to my own body. I shouldn’t have to suffer or left to just rot. I have atypical trigeminal neuralgia (amongst other chronic health issues), and have tried upwards of 25 other non-pharmacological treatments ( homeopathic, home remedies, bizarre suggestions found during desperate late-night searching attempts on the internet and in books, support groups and more). This is all after trying the anti-convulsants that haven’t worked. My life has become a circus of appointments with one bad, egotistical doctor after another. I am the main act.

    I’m only 32.

    I don’t want my body anymore if this cr*p is going to keep happening with doctors, the media, and government officials who think they know more about pain than those who ACTUALLY live it every day! Unfortunately, those people all seem to have more power than us.

    It would help if there was some consistency within the medical field though. Especially before the media gets their grubby hands on it!!!!

  23. Amy V at 10:57 pm

    Just another story to put in the headlines!! Let us tell our story give us our time because it’s well deserved after all this crazy cr*p we have to endure both physically and emotionally. I’ve been on several opioids since 1991 due to chronic cysts and endometriosis which resulted in a hysterectomy in 2006. Years of opioids and never an issue coming off a drug until I was diagnosed with CRPS in 2012 and was placed on CYMBALTA maxed out within six months and on the drug for @4 years and I am in HELL detoxing off this drug!!! I have never in my life experienced anything like this. Severe headaches, brain zaps that stop you in your tracks, nausea, dizziness, etc I can’t function get out of bed etc. this is NOT an OPIOD do not track those on this drug or those not getting enough medication because chronic pain kills!! I’m not saying that opioids are bad for those with addictive personalities but please leave us alone until you live in chronic pain for decades!!

  24. Cynthia at 10:32 pm

    So what is the main issue here….use of long-acting opioids? Or longterm use of all opioids? The article switches from one to the other. Doesn’t make sense to me, confusing,

  25. Matt at 10:15 pm

    My apologies for the typos and George Orwell at the bottom of my post.

  26. Matt at 10:09 pm

    This has to be the apex of idiocy. To give credence to one word in this article is an insult everyone of our collective intellects.

    Well now that the kitchen sink has been thrown at us, what’s next?

    From the Minisrty of Truth –
    The CDC reported today that a clinical study of long term use of opioids for chronic pain resulted in 80% of patients becoming Islamic terrorists.

    “In our time political speech and writing are largely the defense of the indefensible” – George Orwell

    KEEP THE FAITH – KEEP UP THE FIGHT – IT’S YOUR RIGHT!
    George Orwell

  27. Krissy at 9:13 pm

    This is part of the second half of the publicity scheme by the government. All the new articles have some ridiculous study or “finding” to talk about. What they don’t know I guess, is that we know better.

  28. BL at 9:06 pm

    Medicaid patients are generally in poorer health than other patients. I wonder how many had high blood pressure, diabetes and severe heart problems BEFORE being put on pain meds.

  29. Bruce at 8:34 pm

    I had to LEAVE the state of Florida because I could no longer get my prescription filled after the DEA set hard limits on the number of pills to be dispensed by each Pharmacy without regard to patients needs. I now live in Nevada and am limited to 4 pain pills per day regardless of dose because the DEA says that’s what I am supposed to have. Bunch of bastards. This pain – this neuropathic pain is so unbelievable, anybody who doesn’t have it cannot possibly understand -:so quit trying.

  30. Michael G Langley, MD at 8:07 pm

    As I suspected, on first examination of the article, it lacked a,true, scientific basis. Why is it that the high powered anti-epileptics were not seen as more dangerous? Opiates have been used for centuries. Yet, they don’t come up with these findings until after the government, and the media, go after the, proven, safest medication for pain!? NSAIDS were proven to cause more heart attacks. I would think the economic status of the Medicaid patients would likely have had them using that deadly OTC medication, foe years before getting physician prescribed opiates. As Dr Oberg wrote…P-U-L-E-A-S-E!

  31. Tracy at 7:52 pm

    Just another article. Everybody has the answer. Well tell you what, when you can walk in my shoes of constant pain will you understand. My low dose CII works well enough for me to live some sort of life, I don’t expect pain free, just tolerable pain. Leave the chronic pain suffers alone. You never know what the future holds, so don’t take health for granted, you could be the next one suddenly in need.

  32. Pain Patient at 7:50 pm

    “Conclusions and Relevance Prescription of long-acting opioids for chronic noncancer pain, compared with anticonvulsants or cyclic antidepressants, was associated with a significantly increased risk of all-cause mortality, including deaths from causes other than overdose, with a modest absolute risk difference. These findings should be considered when evaluating harms and benefits of treatment.”

    This is directly quoted from the limited amount of the study that they would let you read. MODEST being the opportune word, not to mention who and what they used for the study. Death certificates? Medicaid patients? Did they mention what drugs they studied? Did they mention WHO PAID for this study?? Perhaps PROP? A lot can be gleaned by who pays for a study, and what purpose they have in mind when they suggest a study, which by the way, pays for the bills around there!

    Correlation does not indicate causation. If these people want to put their name on a study, we need to find out what motivated their choice of subjects, why they omitted the type of pain meds, and why they didn’t study the effects of antidepressants which are dangerous in and of themselves. Same for anti-convulsants. Put the two together, and you get an interaction!! This is total BS and written for the sensationalistic press which it will receive. But alas, our comments will never go further than this page.

  33. Christine Taylor at 6:44 pm

    It doesn’t say if those patients were on other medications which I can very well bet they were. At the very least I am betting most of them were on NSAIDS.

    I have always had issues with trying an anti-depressant for pain. I was getting short of breath and 48 hour monitor confirmed multiple arrhythmias. I also become short of breath when my pain is bad as my heart races and does not pump adequately.

    I am waiting to see when the first Human Right’s Complaint is filed with the Ontario Human Rights Board because in our Health Care Consent laws (Both Federal and Provinical) patients are to be informed of the benefits and risks of all treatments and to deny Chronic Pain Patients access to reasonable treatments is to discriminate against them due to illness or disability. Discrimination due to illness/disability is covered in our Human Rights Code. It is the only disability that doctors are flat out refusing to treat with all available medications. The excuse “We don’t feel comfortable” doesn’t cut it because all general practitioners should be well trained in dealing with both short term and long term pain in regards to physio, diet, stress management and medications as pain is a huge component of care. There is an excuse to deny the more specialized treatments such as injections, epidurals etc but plain old school meds should not be an issue.

    I am really tired of people blaming the doctors or the pharmacists. Mention the word “opiate” to anyone and they can tell you that it can be addictive if used improperly. I have heard people say “if only my doctor would have told me”. When there is also the patient specific pamphlet, the pharmacist and the patient insert. If the doctor is prescribing the medication and documenting objective and subjective findings he/she should not be held accountable if their patient fooled them.

    I wonder what the USA Health Care Consent laws state. I read online that some provinces had to make it law that patients be treated adequately for chronic pain but could not find it anywhere. At the very least it is inhumane to withhold medication that may help someone who is not coping with chronic pain using other measures.

  34. Pharmacist Steve at 6:40 pm

    TENN is know to be one of the “epicenters” for abrupt denial of care for those having a medical necessity for opiates… you notice that there is no reference of how many times these pts have been thrown into cold turkey withdrawal by some prescriber or Pharmacist that abruptly turned opiophobic or had a “visit” from some DEA agent making obscure threats about how many opiates that are being written or dispensed. Not to mention the 2-4 pts that will die for every 1000 started on Methadone because not all prescribers are very experienced in properly dosing Methadone.. I suspect that if anyone had access to the raw data on all pts that this report would really look like a piece of Swiss cheese or a puzzle with a lot of piece missing

  35. Anonomous at 6:15 pm

    Teachers cannot reprimand or scold a kid in school anymore. The school is afraid of a lawsuit. This government makes that possible. Even to the point of a teacher getting hurt by a student and they have no recourse.
    Therefore, teachers cannot teach properly.

    Doctors are now under scrutinity because of Opiod prescribing. They can’t help certain patients who are in pain when there is a medicine out there that can help.
    Therefore, they are limited on the help they can give you.
    Brought to you by…The American government.

  36. Terri Lewis PhD at 6:15 pm

    Leading causes of death in Tennessee
    https://www.tn.gov/assets/entities/health/attachments/TnDeaths13.pdf
    Tennessee Drug formularies
    https://tenncare.magellanhealth.com/static/docs/Preferred_Drug_List_and_Drug_Criteria/TennCare_PDL.pdf
    https://www.optumrx.com/pdpclientformulary/formulary.asp?var=2014MCORE&infoid=2014MCORE&page=&par=

    Who is eligible for Tennessee Medicaid?
    https://www.tn.gov/tenncare/article/categories

    Limitations of this study
    1. This was a retrospective study that relied on data coded on death certificates to ascertain all cause mortality (coroners don’t have to be medical professionals in TN – there is no indication that autopsies were conducted to ascertain the relationship of coded cause of death to preexisting conditions for which treatment was addressed.

    2. The data between two groups (opioids and others) were tracked over a number of days. Right off the top, there is variability introduced by unknown conditions associated with chronic pain, the course of illness is unknown, the limitations of the medical health care provided, the limitations of the information that was collected, and the detail on codes that were billed for.

    3. Prescription of long-acting opioids for chronic noncancer pain, compared with anticonvulsants or cyclic antidepressants, was associated with a significantly increased risk of all-cause mortality, including deaths from causes other than overdose, with a modest absolute risk difference. ‘Association’ is not correlation or causation. One cannot conclude, based on the limitations, that there is any real relationship at all that is meaningful from which conclusions should be drawn about treatment decisions that apply to either this population or the population at large.

    4. Cardiac death is the leading COD in Tennessee https://www.tn.gov/assets/entities/health/attachments/TnDeaths13.pdf . It takes years to develop and occurs due to poverty, poor diet, community acquired stress, smoking, exposures to a a variety of illness.

    Claiming that Opioids contribute to the COD seems a little over the top to me. While one may make the claim that in this particular cohort, opiates are more frequently associated with deaths among those who died with heart disease, one cannot make the claim that opiates contribute in any way to heart disease as a cause of death. The information simply doesn’t exist to support this claim. One could just as easily conclude that opioids were prescribed to treat pain associated with heart disease.

    This is a perfect example of the need to understand the limitations of health data when evaluating the soundness of a publication.

  37. Carla Cheshire at 6:02 pm

    As I read this tripe I was thinking when you’re in uncontrolled pain do you really think a person is going to worry that they’re going to have heart problems? A six month study means nothing. Many of us Chronic Pain patients have been taking long acting opioids for over 10+ years. Why don’t they study us? Afraid of what they might find? To them anyone who is successfully using opioids for pain control is an anomaly, when in fact it is the norm when taken as directed. They are skewing data to create an agenda.

  38. Sheryl Donnell at 5:39 pm

    And reading all these comments just makes me want to weep. A long term study? This was a study of 6 months duration. Why not pull the records on all the patients who have been taking opioids for 15 to 20 years? Because then the results would show how safe they have been. Chronic untreated pain causes heart problems. High blood pressure, swelling around the heart, trouble breathing and circulation trouble. This is so disheartening to see a teaching Hospital like Vanderbilt sink to these depths. These drugs have been tested over and over. We need something to give our quality of life back. Unless the CDC is going to force insurance companies to pay for very expensive treatments like spinal cord stimulatorstimulator and intrathecal pain pumps (each surgery over $70k) then let us have the inexpensive meds we have been using safely for years.

  39. Mary Rooney at 5:36 pm

    I find it frightening that so many articles about the dangers of opioids are coming out about so-called scientific studies. Where is the pressure coming from, and what benefit do they provide the people who do them? Obviously the DEA is behind it all, but can that agency engender so much fear that medical professionals in practice and in research feel compelled to show where they stand on this issue? And does the DEA feel it needs these studies so when it moves to make opioids illegal in this country it can cite all these hastily put together and published studies as justification? My wonderful physician, who gave me years of 90% pain relief, lost his license to prescribe and I am now facing loss of home and income because I can’t get enough pain relief to continue to work. Lack of food and medicine will kill me sooner than any so-called cardiac side effects from opioids, but clearly the DEA doesn’t care about my suffering and, sadly, neither do the physicians who are lining up to cover their behinds rather than to follow their vow to care for their patients and alleviate pain and suffering to the best of their ability.

  40. Susan Bond at 5:24 pm

    I’ve been treated with Oxycodone for chronic pain for the past 10 years. Doctors have made me use the Fentynal (sp?) Patch, and morphine. Neither helped with the pain and with each new doctor my dosage has been cut. I’m now ‘allowed’ 8 5mg oxys a day. I had foot surgery last week (bone fusion) and I was prescribed oxy to be used 1 every 4 hours, after major surgery! The paranoia is staggering and it’s those with chronic pain that are needlessly suffering. I’m disabled and am only looking for pain relief to assist me in living a somewhat productive life. Is that really asking for too much?

  41. Holly at 4:28 pm

    The study shows that Medicaid patients taking opioids had a higher risk of death. Patients that take opioids are usually sicker than most, therefore, they die more. No other conclusions can be made. You could just as easily make the (invalid) conclusion that opioids are being appropriately prescribed to sicker patients. The study suggests a topic of interest for further research and nothing more. Peer reviewed doesn’t mean much anymore. Nor are basic scientific and statistical concepts like correlation vs. causation observed.

  42. Richard Oberg M.D. at 4:26 pm

    P-u-l-e-a-s-e- gimme a break. I’d trust anything from Vanderbilt pain as far as I could throw them and this article in nonsense. What a surprise!! Yet another bit of tripe from an organization who’s pain management physicians don’t exactly know what to do with patients having bad chronic diseases except deny them some relief from opioids. We were there and my dermatologist wife with Ehlers-Danlos HM and POTS was told by one of their pain management physicians, ‘I can’t do anything for you – your pain is everywhere’. Sound like a place anyone would like to go for chronic pain management? As one who doesn’t suffer fools and was sitting there, I brought up the infamous ‘opioids’. His response: ‘that’s old school – we don’t do that anymore’.

    So this ‘study’ only looked at Medicaid patients… WELL! That certainly covers the spectrum of people with chronic diseases on opioid therapy and status. And we all know that there are no other co-morbidities or access to care issues involving medicaid patients different than private insurance patients. The article lead-in says ‘MAY increase mortality from cardiorespiratory and other causes’. Any supposed study that starts off with ‘May’ means ‘Maybe not’. Association IS NOT necessarily causation and they prove nothing. ‘Cardiorespiratory’ IS NOT considered a valid cause of death as it tells you basically nothing – physicians are discouraged from putting that on death certificates and most definitely medical examiners. The conclusion takes an additional leap insinuating this might apply to everyone – if not, why not? I’m sure that’s what they’d like to believe and belief shouldn’t be the basis for an article.

    Every article that comes out of this state is anti-opioid PERIOD. Except for the almost obligatory ‘in some cases opioids may be indicated excluding the other 99% of what we said in whatever dumb article’.

    Terri Lewis Ph.D. has written extensively about Tennessee’s abysmal medicaid policies (or lack thereof) and medicaid patients not being able to get access to care…. think any of that might have anything to do with people dying prematurely? Don’t exactly see where they controlled for that.

    Duh???

  43. Karen at 4:17 pm

    I didn’t realize opioids medications were considered to be such a “new”family of pain control medications with so much new and recent research and breakthrough information! I know that, in my case, (in addition to rehabilitative therapies for many years) I endured 15 years of otc NSAIDs as a first line followed by several cox2 Inhibitors (which were subsequently pulled off the market) followed by over a decade of prescription NSAIDs. A diagnosis of Insufficient heart valves, several endoscopies and a diagnosis of severe Gastritis due to so many years on NSAIDs later, I finally was prescribed opioids to help me function with Ehlers-Danlos, arthritis in numerous joints and more. The pain was relieved and I no longer had to deal with numerous stomach lining issues or cardiac risks. I am sorry that all of the new research in this old drug family is so negative, concerning and newsworthy. For some patients however, who have tried many other avenues, the pros wind up outweighing the risks. Nothing in life – or medicine – is “one size fits all” or black and white despite the tendency of many cultures and the respective media outlets to prefer those points of view. Real life experience demands more than a one way/ all or nothing viewpoint

  44. Anonymous at 4:15 pm

    This is the biggest bunch of balony I’ve ever read! How dare they (whoever “they” are) insult my intelligence. All of a sudden it’s bad for your heart? Where was this information over the past 25 years. We’re getting played, people. I took Percocet for 13 years, got off it on my own. Wanted to see if I really needed it, (I do, 2 back surgeries later), and had an EKG this morning and it was fine. All of a sudden when the CDC & DEA decide to “do something about it” does it become bad for your heart. There are thousands of things out there like cigarettes, liquor, guns, etc. TAKE THEM OFF THE MARKET,

  45. Doug at 4:13 pm

    Yes, those of us who take our opioid pain medication as advised by our physicians are outraged at the CDC’s interference in the safe practice and monitored prescribing by our doctors. Then we have the DEA and their Gestapo tactics of putting the fear of God into the honest physicians who are actually thinking of the safty of their patients while treating and helping lessen their pain.

    Our doctors have become afraid, afraid to do the job in which they were trained for. These good and honest physicians have started to question their allegiance and the oaths they took. The few doctors who have resisted the government’s involvement have suffered so many injustices. Like the embarrassment of being arrested on trumped up charges like over prescribing, only to be taken to court or brought before state boards to have their licenses revoked. Just like the age old saying goes, ” it’s my way or the hyway”.
    As far as this article goes, I personally had cardiovascular issues long before I had pain issues. I’ve been talking opiates to manage my pain for just about 10 years now and I haven’t had a single heart related problem since. But, I take all my prescription medications as directed whether they are my heart, diabetes, anxiety or pain medication. I also know other pain sufferers taking opiates to manage their pain who also have heart problems, not a single one of them have had other heart issues while taking their opiates. So in my research over a 10 year period, 0 out of 5 have experienced heart related hospitalization or death while they use their prescription medications as directed by their physicians.

  46. Julie Koehler at 3:59 pm

    Ed-the study was on long term use, yes? Is there a difference recognized between the effect of long acting vs short acting opiates? The article talks mainly about long acting which is why I ask. Thanks. 🙂

  47. Janet at 3:52 pm

    Your study is adjusted to correspond with the untruths spewed by the CDC and FDA and dea. I don’t believe it and with the excruciating pain that I have now that I was abruptly taken off all pain meds why do you think I would care what killed me. Opioids heart problems or suicide. You have no compassion or empathy for others. Crawl back under your rock.

  48. Toni at 3:42 pm

    Maybe people would take less if they increased the strength without all the costs and hoops involved with dr visits and drug testing out of pocket. The bottom line for chronic pain patients is you just have to suffer. Funny though because a lot of other countries do not make their citizens suffer like this or pay so very much.

  49. Patrick T. Hennessey, MD, MPH, FACP at 3:41 pm

    Yet another knee-jerk & simplistic conclusion, not supported by quality data. AT BEST, this is a heuristic study, suggesting a need for further, better-quality studies. Medicaid data are severly-skewed by pathology of poverty and disability. Opiate-treated patients are not necessarily otherwise-identical to patients treated with low-dose antidepressants or anti-epileptic meds (which are, at best, slow-acting, imperfect pain relief ADJUNCTS). And from retrospective, claims-based data, there is no way to control for usual cardiovascular disease risk factors (cholesterol, blood pressure, diabeyes, smoking, obesity), as well as for systemic inflammation. Nor is there any confidence in the validity of the attributable cause of death, especially given the very low frequency of conclusive post-mortem exams.

    At BEST, this should be viewed as a potentially-interesting finding, worth further study (e.g., a better-designed study from a higher-quality database, such as Kaiser). At worst, this is politically-opportunistic health policy wonkery based on junk science wrapped in a once estimable institutional name. But by no means, should this paper be used to justify witholding adequate pain relief.

  50. Doc Anonymous at 3:38 pm

    Only the abstract is available online unless you want to pay $30 for 24 hours of viewing (the authors could have paid an extra fee at time of submitting the paper to make the full content available but they apparently chose not to.) There are a lot of problems with this study based on the abstract. 1. It only followed patients for up to 6 months after starting opioids. Chronic pain patients have already been using opioids for 15 to 20 or more YEARS and therefore this study tells us nothing about the risks for the true chronic pain patient. 2. There is no distinction about diagnosis and comorbidities. It is likely that people with more severe disease and therefore more pain would be more likely to receive long acting opioids. 3. Being a MEDICAID population, it is likely that Methadone was the first choice in long acting opioids because of its low cost and Methadone is known to cause cardiac abnormalities and has an increase risk of fatal cardiac arrhythmia. Statistics that include Methadone would be very misleading unless death rates were classified based on methadone vs. non-methadone cardiac deaths.

    Bottom line: the article seems to be more hype and stigmatization than meaningful statistics. I am willing to re-evaluate if someone can print the full article. And perhaps some of the people from Tennessee can tell us if Methadone is a preferred pain medication under Tennessee Medicaid rules.